ideastream Focus on Mental Health: A Conversation with William Harper

April Baer: Which state budget cuts are likely to have the biggest effect on what you do?

William Harper: Well, certainly any cuts that we get from the Ohio Department of Mental Health are going to hit us directly between the eyes, because we depend on them for a good part of our funding. The Medicaid program involves both the Department of Jobs and Family Services, as well as the Department of Mental Health - and I guess our biggest concern at this point is whether or not the state will continue to fund mental health services under the Medicaid program, because it is an optional benefit. The proposals that are in Columbus at this point seem to be pointing to the discontinuation of the benefit for psychological services which funds private psychological practices around the state. That, in and of itself, will mean more people coming to our public not-for-profit system throughout the state. Medicaid is a big concern but certainly any cuts that go to the Department of Mental Health are a primary concern.

April Baer: How much of the agency's budget comes from the Ohio Department of Mental Health. Or to put this another way, what percentage is local levy dollars?

William Harper: Actually, our local property taxes contribute about 41% of our total budget, which is unusual. That shows a tremendous local contribution to our total budget. State funding is about 33% of our budget, directly from state funds. Then our Medicaid funds from the feds are another 22%. Now that will contrast significantly with what you see in Cuyahoga County where you see a larger portion of their budget is going to be Medicaid.

April Baer: Can you explain why when a state budget gets cut, why the burden on local services becomes greater?

William Harper: Well, when the state budget gets cut you either have to cut services locally, or you have to respond with local tax initiatives. And of course you see that with any sort of political subdivision at a local level whether it's schools, mental health, mental retardation, we are forced to go back to the voters time and time again to see whether or not they're willing to contribute. That's uneven around the state, but we're blessed in Lorain County with having local support. What gets laid on top of that is that we're not seeing fewer people seeking our services in Lorain County. We're seeing 2 times the adults with severe mental illness than we did 10 years ago and 3 times as many kids with serious emotional problems than we did just 10 years ago.

April Baer: How much of that is because of Medicaid enrollment?

William Harper: Well, with kids certainly the S-chip program, the Children's Health Insurance Program, had been a godsend for families that are in poverty who otherwise could not access health services and that's had an impact on the number of kids that can actually get healthcare including mental health services. For the adults really, it's Medicaid. There haven't been more people who necessarily have become eligible for Medicaid, if anything fewer adults have been eligible for Medicaid because of the way the Taniff program works as more and more people have gone off the Taniff roles, fewer people are eligible for Medicaid, primarily woman/head of household type families.

April Baer: I know there's a lot that's up in the air right now, and that's been part of the problem with this story. A lot could change between now and the time Governor Taft signs the budget bill for 2004-2005, but do you expect that Lorain County, under the plan the Governor's now proposing, is going to have to go back to the voters in the next 2 years and ask for more money?

William Harper: Hopefully, with careful fiscal planning, we won't have to go ask for more money. We'll be looking for a renewal of an issue here in another year and a half. For us it's not a crisis situation currently - it's more of a slow strangulation would be one way to describe it, that we're an important part of the infrastructure, the social service/health service infrastructure in Lorain County, and to the extent that we're able to meet local needs, we can have a major impact on our community. If we're not able to meet those needs, then that has am impact on all other services whether it be education or the economic health of the community. So it's not a situation we're going to have to cut programs necessarily immediately, but it will mean that over time we're not going to be able to meet the emerging health needs of Lorain County.

April Baer: What optimal level of services would you like to be able to provide for people?

William Harper: Well, we know from the level of the needs assessments that have been done that there are probably about two times as many people out there now who need our services than we're able to serve right now. That's pretty typical around the country. The penetration rates are really not any better than half of the people that need services. We know 1 out of 5 people are experiencing a mental disorder at any given time. We tend to forget that. We tend to forget that we are only meeting 1/3 to ½ of the people, meeting their needs. It has implications for the community in other ways. You have an impact on everything from divorce rates to crime to the ability of people to keep a steady job and care for their families. It's not something that is an immediate crisis that we can point to and say, "Aha, we need to do something about that." It's more of a slower, kind of a slow death strangulation.

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